Treatment by massage and movement, particularly in relation to fractures / by R.C. Elmslie.

  • Elmslie, R. C. (Reginald Cheyne), 1878-
Date:
1913]
Catalogue details

Licence: Public Domain Mark

Credit: Treatment by massage and movement, particularly in relation to fractures / by R.C. Elmslie. Source: Wellcome Collection.

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    the joint affected and to the importance of its movement, ¢. g. a completely stiff elbow is a great disability, a completely «stiff knee a much less serious thing. fractures.—In the treatment of fractures it is necessary to insist again upon two points. First that massage of fractures should be almost or quite painless, and second that movement means move- ment of the joints and not of the ends of the bones upon each other. The first objects are the prevention of effusion and the reduction of displacement. Considerable effusion and the occurrence of fracture blisters constitute the most serious difficulties in the rational treatment of fractures. It is remarkable that after the opera- tion of osteoclasis, as also after wrenching a foot with the Thomas. wrench, there is never any con- siderable effusion, nor do blisters occur. Yet the violence used must often be as great as is the case in many fractures. I believe that this immunity depends upon the fact that after these operations the injured part is at once covered with a firm bandage and with plaster, applied upwards from the most distal part of the limb. The effusion is thus prevented mechanically. I believe that if we were able to treat all fractures by the immediate applica- tion of firm compression bandage, we should avoid the occurrence of many of these troublesome com- plications. It is essential to remember that in applying such a bandage it must be taken up from the most distal part of the limb. If after an osteoclasis the plaster bandage is applied in such a way that it does not extend down to the level of the toes, it is almost certain that the fore part of the foot will swell. And if on account of this swelling the lowest part of the plaster is cut away, the swelling will extend, until the whole plaster has to be removed. The second point to be attended to in the treat- ment of a fracture is the reduction of the displace- In carrying this out it is always well to analyse the cause of the displacement in the par- ticular fracture, as this will give a clue to the easiest method of reducing it, and will also advise us as to the probability of a recurrence of the deformity after reduction. In some cases the displacement is primarily due to the violence which caused the fracture, as, for example, in Colles’s fracture. In such a case there is little if any tendency to the ment. successfully reduced does not tend to recur, and in most cases could be treated with perfect safety without any splint. In other cases the displace- ment is due to the pull of muscles, as, for example, in a fracture of the shaft of the femur. In such cases reduction has often to be carried out by means of extension, and it tends to recur if the extension is removed until such time as consolidation has taken place. In a third class the displacement is chiefly due to posture or to the weight of the limb, as, for example, in a fracture of the clavicle. In this case reduction is simple and the method of preventing recurrence is obvious. The next point in the treatment of a fracture is the question of splinting. It is sometimes erroneously thought that those who advocate mas- sage and movement in the treatment of fractures attempt to do without the use of splints. This is of course quite untrue. All that they ask is that should be used only for their proper purpose. This purpose is to prevent the recur- rence of deformity after reduction. Splints should never be used to reduce deformity by pressure, and only occasionally should they be used to prevent deformity by posture. Their real use is to prevent such movements on the part of the patient as are likely to reproduce the displacement, and they are only necessary as long as such a recurrent Just as recurrent dis- splints displacement is possible. placement is more likely to occur in one fracture than in another, so splinting may be necessary in In a Colles’s fracture a splint is really scarcely ever necessary ; it is often only used to prevent the patient using the hand; it can be removed for massage from the first, and can be disearded after a week or ten days. In a Pott’s fracture the splint can be removed for massage -after a week, and can be discarded after about a fortnight. In a fracture of the femur the splint can generally be removed for massage and movement after fourteen to twenty-one days, but cannot be discarded before about the sixth much more rapid than is often thought. Organisa- tion of the effusion begins within the first forty- eight hours, and bony callus can be demonstrated in a skiagraph in from fourteen to twenty-one days. In one case of osteotomy in this hospital, treated by massage and without any splint, callus
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